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MACPAC Discusses June Report to Congress

April 11, 2014—The Medicaid and CHIP (Children’s Health Insurance Program) Payment and Access Commission (MACPAC) April 10-11 met to discuss its June report to Congress, which will include chapters on the future of CHIP, state capacity to administer Medicaid and CHIP, Medicaid population health, and long-term services and supports (LTSS).

While MACPAC’s March report to Congress included a section on the short-term future of CHIP [see Washington Highlights, March 21], the June report will focus on long-term concerns with the program.

Under current law, federal CHIP funds will run out shortly after fiscal year (FY) 2015. States with Medicaid expansion programs must maintain these enrollees’ Medicaid coverage, resulting in higher state expenditures for these children. States with separate CHIP programs would no longer be required to finance coverage. As a result, the rate of uninsured children would increase significantly.

The commission discussed several options to alleviate this problem and unanimously approved a recommendation that “Congress should extend federal CHIP funding for a transition period of two additional years during which time the key issues regarding the affordability and adequacy of children’s coverage be addressed.” The recommendation calls on Congress to provide funding through FY 2016 and FY 2017, which is two years beyond the current allocation.

MACPAC staff also provided an overview of the draft June chapter on building state capacity to administer Medicaid and CHIP. Administrative capacity constraints currently hinder states’ ability to meet program requirements, be proactive, and integrate into broader reforms. This chapter will not include any recommendations, but will list several approaches to strengthen state capacity, including increasing the effectiveness of existing resources, sharing resources among states, and leveraging other state assets.

The foundational chapter on Medicaid population health will consist of sections on current population health initiatives and programs, partnerships to improve population health, challenges with these partnerships, and approaches to monitor population health among Medicaid enrollees.

Commission staff also provided a summary of the draft chapter on LTSS. The chapter will include an overview on the fundamentals of LTSS, focusing on which services are covered and who uses them, as well as an analysis of the impact of state variation on LTSS services. Additionally, the chapter will list several ways that MACPAC can address current problems with LTSS, including new options under the Affordable Care Act (ACA, P.L. 111-48 and P.L. 111-52), the expansion of managed LTSS, and how states are using home and community-based services (HCBS) waivers.

The final session of the meeting focused on policy implications of the CHIP Reauthorization Act (CHIPRA) bonus payments, which were authorized under the ACA for FY 2009 through FY 2013 to promote enrollment of eligible but unenrolled children in Medicaid and CHIP.

States were given bonuses for meeting benchmarks in child Medicaid enrollment. During this time, the number of eligible but uninsured children declined by 18 percent, and the national average for Medicaid and CHIP participation rose by 6.4 percent. Overall it was unclear whether the number of uninsured declined due to enrollment strategies that were newly required in the ACA or to the bonus payments. The commission will not include this issue in the June chapter.


Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806

Scott Wetzel, M.P.P.
Lead, Quality Reporting
Telephone: 202-828-0495


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Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.

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Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806